All Answers

• What is off-exchange health insurance?

  Off-exchange health insurance is a private individual or family plan you buy directly from an insurer or a licensed broker instead of through HealthCare.gov, meaning you pay the full-price premium out of pocket with no Marketplace price adjustment applied (HealthCare.gov, 2026).

• How do I buy health insurance off-exchange?

  To buy health insurance off-exchange you enroll directly with an insurance carrier or through a state-licensed independent broker during Open Enrollment or a qualifying Special Enrollment Period, and you pay the full-price premium yourself (HealthCare.gov, 2026).

• What are the health insurance options for business owners?

  A small business owner can either sponsor a group health plan for the company, fund an Individual Coverage HRA (ICHRA) so employees buy their own private ACA plans, or buy an individual ACA-compliant plan personally as a self-employed private buyer (HealthCare.gov; IRS Notice 2020-33).

• What are the health insurance options for 1099 contractors?

  A 1099 contractor is treated as self-employed for health coverage and buys an individual ACA-compliant private plan directly from a carrier or broker, paying the full-price premium out of pocket unless a spouse's group plan is available (HealthCare.gov, 2026; IRS Pub. 535).

• What are the health insurance options for LLC owners?

  A single-member LLC owner is taxed as a sole proprietor and buys an individual ACA-compliant private health plan, deducting the premium above the line as a self-employed health insurance deduction to the extent of net LLC profit (IRS Publication 535).

• How does health insurance work for S-corporation owners?

  An S-corporation shareholder-employee who owns more than 2% of stock has the company pay or reimburse the ACA-compliant private health premium, include the amount in the shareholder's W-2 Box 1 wages, and the shareholder then deducts it as a self-employed health insurance deduction on Form 1040 (IRS Notice 2008-1).

• What is a private PPO with a broad network?

  A private PPO with a broad network is an ACA-compliant Preferred Provider Organization plan whose in-network provider list covers a large share of national or regional hospitals and specialists, letting you see most in-network doctors without a referral and pay reduced coinsurance (HealthCare.gov Glossary — PPO).

• What is the difference between a broad-network and a narrow-network PPO?

  A broad-network PPO contracts with a large share of hospitals and specialists in an area (or nationally), while a narrow-network PPO contracts with a smaller, negotiated subset in exchange for lower premiums (HealthCare.gov Glossary — Network).

• What is a COBRA alternative for high earners?

  The most common COBRA alternative for a high earner is an individual ACA-compliant private plan bought off-exchange from the same or a comparable carrier, since COBRA premiums are billed at the full group rate plus a 2% administrative fee under federal law (U.S. Department of Labor — COBRA, 2024).

• Private health insurance for a 1099 vs COBRA — which makes sense?

  For a 1099 contractor leaving a W-2 job, an individual ACA-compliant private plan is often less expensive than COBRA because COBRA is charged at the full group rate plus a 2% administrative fee, while a private off-exchange plan is priced on your age and rating area (U.S. Department of Labor — COBRA, 2024).

• What is short-term health insurance for a coverage gap?

  Short-term, limited-duration insurance (STLDI) is temporary private health coverage sold outside the ACA framework that can bridge a short coverage gap but does not cover pre-existing conditions and is not required to include essential health benefits (HealthCare.gov — Short-Term Plans).

• What is a high-deductible health plan for a self-employed buyer?

  For 2026, an HSA-qualifying high-deductible health plan (HDHP) is defined by the IRS as a plan with a minimum annual deductible of $1,700 self-only or $3,400 family and an out-of-pocket maximum no greater than $8,500 self-only or $17,000 family (IRS Rev. Proc. 2025-19).

• What are the HSA contribution limits for 2026?

  For 2026, the IRS HSA contribution limits are $4,400 for self-only HDHP coverage and $8,750 for family HDHP coverage, plus a $1,000 catch-up contribution for accountholders age 55 or older (IRS Rev. Proc. 2025-19).

• What are the dental and vision options for the self-employed?

  Self-employed buyers can add a standalone private dental plan and a standalone vision plan directly from a carrier or broker, either alongside an off-exchange medical plan or through the Marketplace where dental is sold as a separate plan (HealthCare.gov — Dental Coverage).

• What are HSA-eligible plans for self-employed buyers?

  HSA-eligible plans for self-employed buyers are private ACA-compliant high-deductible health plans that meet the IRS 2026 definition of an HDHP (minimum deductible $1,700 self-only / $3,400 family; out-of-pocket max no more than $8,500 / $17,000), letting the accountholder open and fund a Health Savings Account (IRS Rev. Proc. 2025-19).

• How does an ICHRA work for business owners?

  A business owner uses an ICHRA by setting a fixed monthly allowance in defined employee classes, and the ICHRA then reimburses each employee pre-tax for the individual ACA-compliant health insurance premium (and, if the plan allows, other qualified medical expenses) they buy on their own (HealthCare.gov — ICHRA).

• How much does private health insurance cost out of pocket?

  The out-of-pocket cost of a private health insurance plan is the full-price monthly premium plus the plan's deductible, copays, and coinsurance up to the annual out-of-pocket maximum, which for 2026 cannot exceed $10,600 self-only and $21,200 family under CMS rules (CMS Notice of Benefit and Payment Parameters, 2026).

• Can I buy private health insurance any time of year?

  You can only enroll in an ACA-compliant private health insurance plan during federal Open Enrollment or during a 60-day Special Enrollment Period triggered by a qualifying life event such as loss of coverage, marriage, birth, or a permanent move (HealthCare.gov — Special Enrollment Period).

• How much does a concierge medicine membership cost?

  Concierge medicine memberships are private out-of-pocket monthly or annual fees paid directly to a physician practice for enhanced access and are separate from health insurance; you still need an ACA-compliant private health plan for hospital and specialist coverage (HealthCare.gov Glossary — Supplemental Coverage).

• Direct primary care vs health insurance — what's the difference?

  Direct primary care (DPC) is a monthly membership paid directly to a primary-care practice for routine visits and is not health insurance, so DPC members generally still need a private ACA-compliant plan for hospital, specialist, and catastrophic coverage (HHS ASPE — Direct Primary Care brief).

• What is direct primary care?

  Direct primary care (DPC) is a physician-practice model in which patients pay a flat monthly or annual membership fee directly to a primary-care practice for routine visits, in place of billing insurance for those services (HHS ASPE — Direct Primary Care research brief).

• What is supplemental health insurance for self-pay buyers?

  Supplemental health insurance is a private policy that pays cash or specific benefits on top of a primary health plan for events like accidents, critical illness, or hospital stays, and it does not replace an ACA-compliant private plan (HealthCare.gov Glossary — Supplemental Coverage).

• How does in-network vs out-of-network work on a PPO?

  On a private PPO, in-network care is billed at the insurer's contracted rate with lower deductible, copay, and coinsurance, while out-of-network care is billed at the provider's charge with higher cost-sharing and possible balance billing (HealthCare.gov Glossary — Network).

• What is a deductible on a private health plan?

  A deductible is the amount you pay out of pocket for covered health services before your private health plan starts paying, and it resets each plan year (HealthCare.gov Glossary — Deductible).

• What is coinsurance on a private health plan?

  Coinsurance is the percentage of the cost of a covered health service you pay after you've met your deductible, and it applies until you reach the plan's out-of-pocket maximum (HealthCare.gov Glossary — Coinsurance).

• What is an out-of-pocket maximum on a private health plan?

  The out-of-pocket maximum is the most you have to pay in a plan year for covered in-network essential health benefits, and once you hit it the plan pays 100% of allowed charges for the rest of the year; for 2026 the federal cap is $10,600 self-only and $21,200 family (CMS Notice of Benefit and Payment Parameters, 2026).

• How do claims work on a private PPO?

  On a private PPO, the in-network provider submits a claim to your insurer, the insurer applies the contracted rate against your deductible and coinsurance, and you are billed the remaining member responsibility (HealthCare.gov Glossary — Claim).

• How does prior authorization work on a private PPO?

  Prior authorization is a private health plan's requirement that a provider get approval from the insurer before certain services, drugs, or equipment will be covered, and failure to obtain it can lead to a denied claim (HealthCare.gov Glossary — Prior Authorization).

• What is a private family plan for a self-employed buyer?

  A private family plan for a self-employed buyer is a single ACA-compliant individual-market policy covering the applicant, spouse, and dependent children, purchased off-exchange from a carrier at the full-price family premium and eligible for the self-employed health insurance deduction (IRS Publication 535).

• Private vs employer health insurance — which is better for a business owner?

  A business owner without employees usually finds an individual private ACA-compliant plan less expensive and more flexible than sponsoring a group plan, while an owner with W-2 staff often compares a group plan, an ICHRA, and a raise-in-lieu before choosing (HealthCare.gov — ICHRA).

• What counts as full-price premium on a private health plan?

  Full-price premium is the unadjusted monthly cost of a private ACA-compliant health plan as quoted by the insurer for the buyer's age, ZIP code, tobacco status, and family composition, with no Marketplace price adjustment applied (HealthCare.gov Glossary — Premium).

• What are the health insurance options for gig workers?

  Gig workers who file a 1099 buy individual ACA-compliant private health insurance directly from a carrier or broker and pay the full-price premium themselves, and if their gig work generates net profit they can claim the self-employed health insurance deduction (IRS Publication 535).

• What are the health insurance options for early retirees before Medicare?

  Early retirees who leave work before age 65 typically bridge to Medicare with an individual ACA-compliant private plan bought off-exchange at full-price premium, an on-exchange plan through HealthCare.gov, or COBRA continuation coverage for up to 18 months from the former employer (Medicare.gov; DOL COBRA).

• How much does a private PPO cost?

  The monthly premium for a private ACA-compliant PPO varies by age, ZIP code, tobacco status, and metal tier, and is quoted at full price when bought off-exchange because no Marketplace price adjustment is applied (HealthCare.gov Glossary — Premium).

• What are the private health insurance options for high earners who buy off-exchange?

  High earners who do not use HealthCare.gov Marketplace pricing help buy the same ACA-compliant private plan off-exchange directly from the carrier or an independent broker and pay the full-price premium out of pocket (HealthCare.gov, 2026).

• What is an ICHRA (Individual Coverage HRA)?

  An Individual Coverage Health Reimbursement Arrangement (ICHRA) is an employer-funded account that reimburses employees on a pre-tax basis for premiums and medical expenses of individual ACA-compliant health insurance they buy themselves, in place of a traditional group plan (HealthCare.gov — ICHRA; IRS final rules, 2019).

• What are the health insurance options for the self-employed?

  The self-employed typically buy an individual ACA-compliant private health plan off-exchange or on-exchange, and if they have net self-employment income they can deduct the premium above the line under the self-employed health insurance deduction (IRS Publication 535).